Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
PLoS One. 2019 Sep 12;14(9):e0222118. doi: 10.1371/journal.pone.0222118. eCollection 2019.
Obesity and metabolic syndrome (MetS) are associated with high risk of cardiac dysfunction and heart failure. We assessed the effect of obesity and metabolic health status on left ventricular (LV) structure and function in subjects without overt heart disease.
In 789 subjects (58.8±13.0 years, 50.7% males) without overt heart disease, LV morphology and function were compared among 6 groups stratified by body mass index (BMI) (normal weight, overweight and obese) and metabolic health status (meeting ≤1 criterion of MetS excluding waist circumference defined as metabolically healthy; otherwise, metabolically unhealthy).
LV ejection fraction (LVEF) was not different among the 6 groups (P>0.05). However, high BMI and poor metabolic health were associated with poorer global longitudinal strain (GLS), higher LV mass index (LVMI) and higher E/e' (P<0.001). Poor metabolic health status was associated with greater adverse changes in LV structure and function than obesity, and among MetS components, high systolic blood pressure (SBP) showed the greatest impact. Higher SBP, BMI and triglycerides were independently associated with worse GLS, and higher SBP was also associated with worse LVMI and E/e´. GLS, LVMI and E/e´ worsened in proportion to the number of MetS criteria or continuous MetS scores. Adverse myocardial changes associated with obesity were significant in the metabolically healthy group, but not in the metabolically unhealthy group.
Obesity and poor metabolic health status were associated with subclinical decrement in LV systolic and diastolic function, and higher LV mass, but not with LVEF, in subjects without overt heart disease.
肥胖和代谢综合征（MetS）与心脏功能障碍和心力衰竭的高风险相关。我们评估了肥胖和代谢健康状况对无明显心脏病患者左心室（LV）结构和功能的影响。
在 789 名无明显心脏病的受试者中（58.8±13.0 岁，50.7%为男性），根据体重指数（BMI）（正常体重、超重和肥胖）和代谢健康状况（符合 MetS 标准，但不包括腰围，定义为代谢健康；否则为代谢不健康）将 LV 形态和功能在 6 组中进行比较。
6 组间 LV 射血分数（LVEF）无差异（P>0.05）。然而，高 BMI 和不良代谢健康与较差的整体纵向应变（GLS）、较高的 LV 质量指数（LVMI）和较高的 E/e'相关（P<0.001）。不良代谢健康状况与 LV 结构和功能的不良变化比肥胖更为相关，在 MetS 成分中，高收缩压（SBP）的影响最大。较高的 SBP、BMI 和甘油三酯与较差的 GLS 独立相关，较高的 SBP 也与较差的 LVMI 和 E/e'相关。GLS、LVMI 和 E/e'随着 MetS 标准或连续 MetS 评分的增加而恶化。与肥胖相关的不良心肌变化在代谢健康组中显著，但在代谢不健康组中不显著。
肥胖和不良代谢健康状况与无明显心脏病患者 LV 收缩和舒张功能的亚临床减退以及较高的 LV 质量相关，但与 LVEF 无关。
